Foster youth transitions to adulthood: a longitudinal view of youth leaving care.

The well-being of youths who age out of the out-of-home care system in the U.S. has long been of great interest to child welfare practitioners and policymakers. In spite of this interest, however, very little is known about how these youths fare when they must make the transition to independence. The Foster Youth Transitions to Adulthood Study is tracking the experiences of 141 young adults who left care in Wisconsin in 1995 and 1996. This article describes these youths and their experiences in the first 12 to 18 months after leaving care. The findings suggest that the transition to independence is a difficult time for youth leaving the out-of-home care system.

National call to action: Working toward the elimination of child maltreatment. The economics.

No reliable estimates exist of the overall costs to society of child maltreatment that will withstand serious examination. Arguably some of the most important human costs of maltreatment are unquantifiable. Moreover, in many cases it is difficult if not impossible to separate the economics of child abuse and neglect from the economics of a host of other problems facing families. Still, even conservative estimates of government spending on behalf of abused and neglected children and their families illustrate that child maltreatment costs society a great deal, with much of that expense going for deep-end intervention rather than family support and prevention. Government expenditures directed at this social problem have grown rapidly since the rediscovery of child abuse in the 1960s and now exceed spending for a number of essential supports for children and families. Moreover, the new era of continuing commitment to child protection in the context of a revised social contract with the nation's poor raises serious questions about the economics of child maltreatment in the future.

The costs of child protection in the context of welfare reform.

The financing structure of any large public service system both reveals the priorities held by policymakers and drives the delivery of services. Of the $11.2 billion in public funds for child welfare services, somewhat less than half is federal. As this article explains, federal funds for child welfare overwhelmingly go to support out-of-home care (foster care and adoption services), and these costs have risen sharply in recent years. In contrast, federal funding for child protection investigations, prevention programs, and treatment services is more limited, and expenditures have not risen apace with reports of maltreatment. The article compares the high cost of foster care with the lower per capita cost of cash assistance to poor families and the per-case costs of child protection investigations and service provision. Pointing out that the great majority of families served by the child welfare system are poor, the author argues that child welfare and cash assistance should be seen and analyzed as interrelated programs serving poor families. The article examines the varied ways in which the changes in cash assistance programs introduced by the 1996 federal welfare reform law may increase the need for child welfare services and drive up the costs of child protection.

Stress and immune responses after surgical treatment for regional breast cancer.

BACKGROUND: Adults who undergo chronic stress, such as the diagnosis and surgical treatment of breast cancer, often experience adjustment difficulties and important biologic effects. This stress can affect the immune system, possibly reducing the ability of individuals with cancer to resist disease progression and metastatic spread. We examined whether stress influences cellular immune responses in patients following breast cancer diagnosis and surgery. METHODS: We studied 116 patients recently treated surgically for invasive breast cancer. Before beginning their adjuvant therapy, all subjects completed a validated questionnaire assessing the stress of being cancer patients. A 60-mL blood sample taken from each patient was subjected to a panel of natural killer (NK) cell and T-lymphocyte assays. We then developed multiple regression models to test the contribution of psychologic stress in predicting immune function. All regression equations controlled for variables that might exert short- or long-term effects on these responses, and we also ruled out other potentially confounding variables. RESULTS: We found, reproducibly between and within assays, the following: 1) Stress level significantly predicted lower NK cell lysis, 2) stress level significantly predicted diminished response of NK cells to recombinant interferon gamma, and 3) stress level significantly predicted decreased proliferative response of peripheral blood lymphocytes to plant lectins and to a monoclonal antibody directed against the T-cell receptor. CONCLUSIONS: The data show that the physiologic effects of stress inhibit cellular immune responses that are relevant to cancer prognosis, including NK cell toxicity and T-cell responses. Additional, longitudinal studies are needed to determine the duration of these effects, their health consequences, and their biologic and/or behavioral mechanisms.

The effects of auditory stimulation on the arithmetic performance of children with ADHD and nondisabled children.

This study evaluated the impact of extra-task stimulation on the academic task performance of children with attention-deficit/hyperactivity disorder (ADHD). Twenty boys with ADHD and 20 nondisabled boys worked on an arithmetic task during high stimulation (music), low stimulation (speech), and no stimulation (silence). The music "distractors" were individualized for each child, and the arithmetic problems were at each child's ability level. A significant Group x Condition interaction was found for number of correct answers. Specifically, the nondisabled youngsters performed similarly under all three auditory conditions. In contrast, the children with ADHD did significantly better under the music condition than speech or silence conditions. However, a significant Group x Order interaction indicated that arithmetic performance was enhanced only for those children with ADHD who received music as the first condition. The facilitative effects of salient auditory stimulation on the arithmetic performance of the children with ADHD provide some support for the underarousal/optimal stimulation theory of ADHD.

Race and child welfare services: past research and future directions.

A review of child welfare research suggests that children of color and their families experience poorer outcomes and receive fewer services than their Caucasian counterparts. The relationship between race and the outcomes of child welfare services is confounded, however, by the relationships among race and other contributors to poor child welfare outcomes. Child welfare researchers should take explicit account of race and ethnicity in designing and carrying out their studies. Service approaches intended to meet the special needs of children of color and their families should be developed and rigorously evaluated.

Pathways of older adolescents out of foster care: implications for independent living services.

This article reports the results of a study of final discharge outcomes for an exit cohort of 2,653 foster youths in California who were at least 17 years old at exit and had spent at least 18 months in care before their final discharge. A logistic regression model of discharge status was developed that expresses the effect of selected variables on the odds that a child exited foster care via one of three routes: (1) by reaching the age of majority while still in care or being legally emancipated to independent living; (2) by family reunification, placement with a relative or guardian, or adoption; or (3) by an "unsuccessful" exit from care. A youth's number of placements in foster care, time spent in care, and the type of placement the child last resided in were all found to be related to final discharge status. The implications of these findings for efforts to prepare foster youths for independent living are discussed. Of particular interest is the finding that a large proportion of youths who have spent a long time in foster care away from their families nevertheless return to their families at exit from care.

New challenges and opportunities in child welfare outcomes and information technologies.

In spite of longstanding concern on the part of child welfare policymakers, researchers, and practitioners, we still lack basic information about the outcomes of child welfare services. This article describes the limitations of current efforts to generate data on child welfare outcomes, presents certain principles for the development of child welfare management information systems for the 21st century, and suggests steps to be taken to get from here to there. Particular attention is given to recent federal initiatives that provide an immediate opportunity to make a fundamental leap in our ability to understand the outcomes of child welfare services.

Trypanosomiasis in the Rumphi district

Sleeping sickness; or African trypanosomiasis; is a common cause of admission to Rumphi District Hospital. This article studies the features of the disease as presented in hospital and the screening of susceptible persons in the community for parasitemia during 1984

Epidermal growth factor in human milk: daily production and diurnal variation during early lactation in mothers delivering at term and at premature gestation.

Epidermal growth factor is a polypeptide that stimulates proliferation and differentiation of a variety of cell types, including the developing intestinal epithelium; it is the agent in human milk that induces mitosis in human fibroblast culture. We systematically evaluated the EGF content of milk from 20 women delivering prematurely and from 11 women delivering at term. In preterm mothers, the concentration of EGF was 70 +/- 5 ng/ml (mean +/- SEM), with no significant change during seven weeks of lactation. EGF concentration in milk of term mothers was 68 +/- 19 ng/ml (mean +/- SEM). No diurnal variation in the concentration was found. Total EGF content was closely correlated with the volume of milk expressed, suggesting a passive transport from the circulation. These observations confirm that a substantial amount of EGF is present in human milk and that EGF concentrations are not affected by duration of gestation, time of day, or duration of lactation.

Rapidly declining serum albumin values in newly hospitalized patients: prevalence, severity, and contributory factors.

We had noted that a number of hospitalized patients showed abnormally low serum albumin levels within a few days of admission, although the albumin had been normal at admission. Since this rapid decline in albumin could not be accounted for on the basis of starvation, we hypothesized that the changes were due to the increase in intravascular fluid volume which normally occurs with assumption of the recumbent position. Since albumin is often a nutritional screening parameter in hospitalized patients, it is important to ascertain the incidence of such profound changes in albumin as well as to identify possible causes for this change. A survey of 34 concurrent hospital admissions showed that 28 out of 34 (82%) patients had a decline in serum albumin within 5 days of hospitalization. These 28 patients had a decrease of 0.5 +/- 0.09 g/dl. Twenty-five additional patients were studied in order to elucidate causative factors. Twenty out of the 25 showed a decrease in serum albumin within 5 days of admission (mean decrease 0.5 +/- 0.05 g/dl). Hemoglobins in these patients decreased by a mean of 1.1 +/- 0.34 g/dl (p less than 0.01), but BUN and uric acid levels did not change significantly. The one factor common to all patients with declining albumin values was change in posture. All patients were ambulatory at the time of the initial albumin determination but were on bedrest for at least 6 1/2 hours before the second determination. The findings indicate that most hospitalized patients have significant changes in serum albumin levels which occur with change in posture. If the albumin level is to be used as a nutritional indicator, the patient's position at the time of phlebotomy is essential for accurate interpretation of results.